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the image.",{"id":215,"name":216},1,"Course previews",[218,229,234,239,246],{"type":219,"data":220},"video",{"readDurationInSeconds":221,"video":222},229,{"platform":223,"name":224,"url":225,"size":226},"Vimeo","Chest X-Ray Promo 4","https:\u002F\u002Fvimeo.com\u002F142851815",{"width":227,"height":228},480,270,{"type":230,"data":231},"free_text",{"readDurationInSeconds":232,"text":233},22.933333333333334,"\u003Cp dir=\"ltr\">A normal chest x-ray has a certain grayscale pattern based on tissue density, geometry, interfaces, and overlap. When pathology occurs in the thorax, the pathology causes the normal grayscale of the chest x-ray to change in several ways. In this video from our Chest X-Ray Essentials course, Julian Dobranowski, MD, will cover important concepts such as pneumothorax and pleural effusion in depth, as he explains how pathology can change the grayscale of the x-ray image.\u003C\u002Fp>\u003Cp>This is the final video in a 4-part series on chest x-ray problems:\u003C\u002Fp>\u003Cul>\u003Cli>\u003Ca href=\"https:\u002F\u002Fwww.medmastery.com\u002Fmagazine\u002Fgetting-chest-x-ray-importance-greyscale-part-1\">Watch video #1: The importance of grayscale\u003C\u002Fa>\u003C\u002Fli>\u003Cli>\u003Ca href=\"https:\u002F\u002Fwww.medmastery.com\u002Fmagazine\u002Fgetting-chest-x-ray-importance-overlap-part-2\">Watch video #2: The importance of overlap\u003C\u002Fa>\u003C\u002Fli>\u003Cli>\u003Ca href=\"https:\u002F\u002Fwww.medmastery.com\u002Fmagazine\u002Fgetting-chest-x-ray-importance-shapes-and-key-landmarks-part-3\">Watch video #3: The importance of shapes and key landmarks\u003C\u002Fa>\u003C\u002Fli>\u003C\u002Ful>",{"type":230,"data":235},{"readDurationInSeconds":236,"title":237,"text":238},11.466666666666667,"Join our Chest X-ray Essentials course today!","\u003Cp class=\"lead\">If you want to take your chest x-ray skills to the next level, then check out our \u003Ca href=\"https:\u002F\u002Fwww.medmastery.com\u002Fcourse\u002Fchest-x-ray-essentials\">Chest X-ray Essentials course\u003C\u002Fa>, which was specifically designed for non-radiologists who want to use the chest x-ray in order to make better clinical decisions.\u003C\u002Fp>",{"type":240,"data":241},"cta",{"readDurationInSeconds":242,"text":243,"buttonText":244,"buttonUrl":245},3.466666666666667,"Become a great clinician with our video courses and workshops","Start learning for free","https:\u002F\u002Fwww.medmastery.com\u002Fuser\u002Fregister",{"type":230,"data":247},{"readDurationInSeconds":248,"title":249,"text":250},111.46666666666667,"Video Transcript","\u003Cp dir=\"ltr\">\u003Cstrong>[00:00:00] \u003C\u002Fstrong>What will I gain from this video? At the end of the video, you will know about the various ways that pathology can change the normal grayscale on a chest x-ray. Previously, we have learned that a normal chest x-ray has a certain grayscale pattern based on tissue density, geometry, interfaces, and overlap. When pathology occurs in the thorax, the pathology causes the normal \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:00:30] \u003C\u002Fstrong>grayscale of the chest x-ray to change in several ways. A normal gray structure can become too black or too white or a normally black structure can become gray or too white or a normally white structure can become gray or too black. Here, we have an example of a normal chest x-ray. If we focus on the left hemithorax, this is what normal looks like. In this example, here, we see that the left hemithorax is too white. The reason the left hemithorax is white is \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:01:00] \u003C\u002Fstrong>because the left lung is collapsed. On this example, here, we see that the left hemithorax is too black. The reason it is too black is because there's air outside of the lung. We will learn more about this in later presentations but what this patient has is a pneumothorax. And because the heart and the mediastinal structures are shifted to the right side, this is called a tension pneumothorax. \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:01:30] \u003C\u002Fstrong>The grayscale of the structure can stay the same, but the structure can increase or decrease in size. Here, we have an example of normal. If we focus on the central structures, we can see the normal appearance of the heart. On this example, we see that the heart is grossly enlarged. The normal thoracic aorta lies in this region. In this case, this interface \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:02:00] \u003C\u002Fstrong>that we are seeing is caused by a grossly dilated aorta, in this patient with a thoracic aortic aneurysm. The grayscale of the structure can stay the same but the structure can be displaced horizontally or vertically. Or the grayscale of the structure can stay the same but the shape of the structure can become distorted. Now, let's do some example cases. These are two x-rays of the same patient. If we look on this x-ray, we can identify that within the left \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:02:30] \u003C\u002Fstrong>side, inferiorly, there is an increased density. It's too white when compared to the normal x-ray on the left. The reason for this is because the patient has a left-sided pneumonia. On these two x-rays of the same patient, we see that there's a big difference. On this x-ray, we see this whiteness, inferiorly on the right and on the left side, which was not present on the previous \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:03:00]\u003C\u002Fstrong> examination. The patient has developed bilateral pleural effusions. In this case, we see that it is too black within this hemithorax as compared to the other x-ray, which is normal. The reason for that is because the patient has a pneumothorax. Because the heart and mediastinal structures are shifted to the right, this is classified and call as a tension pneumothorax. \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:03:30] \u003C\u002Fstrong>So in recap, the abnormalities within the thorax can be classified as too white, too black, the pathology can be too black and too white. And I'll explain how that can occur in a future video.\u003C\u002Fp>",{"courses":252,"showAwardsBelow":48},[253],{"id":254,"isFreeCmeCourse":255,"title":256,"type":257,"specialization":258,"teachers":260,"cmeCredits":262,"teacherIllustration":263,"backgroundImage":264,"relativeUrl":265,"lastChanged":266,"created":267,"description":268,"relativeURL":265,"meta":269},2306,false,"Chest X-ray Essentials","course",[259],"Imaging",[261],"Julian Dobranowski, MD FRCPC FCAR",7,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55ee1-2bf6-4868-b522-41b77b292f87","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55ee1-fab8-4cd9-8802-795e1f366ede","\u002Fcourses\u002Fchest-x-ray-essentials","1769602519","1444327895","Being able to interpret the basic findings on a chest x-ray (CXR) is one of the most important clinical skills. 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Come in and become an expert.",{"duration":270,"quizzes":271,"lessons":272},18759,12,78,{"id":274,"name":261,"image":275,"profession":276,"relativeUrl":279,"specializations":280},2307,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43ceff-b005-4edc-8fb3-8afbb49b8f7e",{"name":277,"description":278},"Diagnostic imaging specialist","Chief of Diagnostic Imaging at Niagara Health in Ontario, Canada. \r\nProfessor and Chair of the Department of Radiology, McMaster University.","\u002Fteachers\u002Fjulian-dobranowski-md-frcpc-fcar",[259],157,"3m",[284,311,330],{"id":285,"title":286,"text":287,"image":288,"author":296,"path":305,"readDuration":306,"readDurationFormatted":282,"internal":307},1350,"How to Recognize INOCA (ANOCA) on an Exercise Stress Test ","Angina, abnormal stress test, clean coronaries—that's INOCA (or ANOCA), and it carries real risk. Learn to recognize and report it with exercise stress ECG.",{"alt":289,"title":290,"size":291,"location":293},"Illustration of the heart's coronary vasculature showing large coronary arteries and the extensive network of smaller vessels affected in INOCA (ischemia with nonobstructive coronary arteries).","",{"width":292,"height":292},1200,{"bucket":294,"key":295},"public-drupal-medmastery-assets-production","\u002F2026-05\u002FC17(1)_magazine image_0.png",{"id":297,"title":298,"relativeURL":299,"image":300,"professionLong":301,"profession":302,"weight":304},1563,"Franz Wiesbauer, MD MPH","\u002Fteachers\u002Ffranz-wiesbauer-md-mph","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cef0-41ee-4005-9e4a-d8711c816401","Franz is the founder and CEO of Medmastery. He is an internist with a specialization in cardiology and a master’s in public health from Johns Hopkins University.",{"name":303},"Internist",4,"\u002Fmagazine\u002Fexercise-stress-ecg-inoca",141,{"created":308,"updated":309,"published":310},1778115738,1778118425,1778118255,{"id":312,"title":313,"text":314,"image":315,"author":321,"path":323,"readDuration":324,"readDurationFormatted":325,"internal":326},1348,"Hyperlipidemia screening: who, when, & what to measure","Testing for hyperlipidemia can help you mitigate your patients' cardiovascular risk. Learn who to screen and when, which measures to request, and how to stratify risk.",{"alt":316,"title":290,"size":317,"location":319},"Lipid panel blood sample tubes used to test for hyperlipidemia in a laboratory setting",{"width":318,"height":318},600,{"bucket":294,"key":320},"\u002F2026-04\u002FC121_magazine image.png",{"id":297,"title":298,"relativeURL":299,"image":300,"professionLong":301,"profession":322,"weight":304},{"name":303},"\u002Fmagazine\u002Ftest-for-hyperlipidemia",246,"5m",{"created":327,"updated":328,"published":329},1777403036,1777572381,1777412421,{"id":331,"title":332,"text":333,"image":334,"author":339,"path":348,"readDuration":349,"readDurationFormatted":350,"internal":351},1347,"Outpatient care for COPD exacerbations","Most acute COPD exacerbations can be managed with outpatient treatment. Learn how to treat mild and moderate COPD exacerbations—and when to escalate care.",{"alt":335,"title":290,"size":336,"location":337},"Older patient using a handheld nebulizer to inhale bronchodilator medication during an acute COPD exacerbation",{"width":318,"height":318},{"bucket":294,"key":338},"\u002F2026-04\u002FC133(4)_ exacerbations_magazine image.png",{"id":340,"title":341,"relativeURL":342,"image":343,"professionLong":344,"profession":345,"weight":347},5365,"Siamak Moayedi, MD","\u002Fteachers\u002Fsiamak-moayedi-md","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cf02-1064-4074-817b-0eb5de6ded74","Professor and Director of Medical Student Education, University of Maryland and Course Director, Essential and Critical Procedures, Emergency Medicine.",{"name":346},"Emergency medicine physician",1533,"\u002Fmagazine\u002Facute-copd-exacerbation-treatment",191,"4m",{"created":352,"updated":353,"published":354},1776705362,1776710540,1776710541,{"seo":356,"og":358},{"title":357,"description":213},"Getting into the chest x-ray (part 4): How pathology changes the  | Medmastery",{"title":359,"description":213,"image":360},"Getting into the chest x-ray (part 4): How pathology changes the grayscale  | Medmastery",{"alt":290,"title":290,"size":361,"location":363},{"width":362,"height":362},220,{"bucket":294,"key":364},"\u002Fmigrated-images\u002Fmagazine_151019.jpg",{"id":366,"created":367,"updated":368,"published":367},73,1445242819,1735914177]